How to cover deductibles and limits imposed by your primary health insurance plan
Administered by Mestmaker & Assoc.
Underwritten by AmFirst Insurance Company
CMRP is designed to reimburse most out-of-pocket cancer expenses not paid in full by your primary health insurance plan.
Most health plans do not pay 100% of all claim expenses. There are doctor fees, lab charges, x-rays, chemotherapy, radiation, prescription drugs, and other hospital costs. Much of the time, they have exceeded the basic allowances of insurance. Almost all primary health insurance plans have both limits and deductibles. The Cancer Medical Reimbursement Plan (CMRP) can step in and help. Any cancer related expense not fully reimbursed by your primary health insurance plan may be eligible for payment.
The Basic Benefits Include
CMRP is intended to supplement your existing primary health insurance plan. It is meant to provide reimbursement for covered medical expenses of cancer. It has a $1,000,000 lifetime maximum.
CMRP will reimburse your primary health insurance plan deductible amount up to $500 per calendar year for cancer and dread disease related expenses. CMRP will also reimburse any coinsurance or copayments you make, provided it is a covered expense under your primary health insurance plan (subject to limits in our policy).
Pricing
CMRP only costs $56 a year for an individual, or $62 a year for the entire family
For less than twenty cents a day, you can provide yourself and your eligible family members with this valuable protection. The CMRP offers many payment options either monthly or annually via payroll deduction, electronic funds transfers, and credit card deductions.
Administered by
MWG Mestmaker & Assoc.
P.O. Box 2302
Bakersfield, CA 93303
661-325-5999
I.B.S. Inc.
P.O. Box 396
Kaukauna, WI 54130
920-730-8000
Fax: 920-730-8951
Underwritten by
AmFirst Insurance Co.
P.O. Box 14067
Jackson, MS 39236
1-800-800-1397
www.amfirstinsco.com
How to Guarantee Eligibility
All you need is a primary health insurance plan, which is a comprehensive health plan that pays at least 70% of major medical expenses, including treatment of cancer and other dread diseases specified in the CMRP policy. If you have Medicare, you must have both parts A and B. In addition to parts A and B, you must carry a paid supplemental plan. This supplemental plan, when combined with Medicare pays a minimum of 70% of eligible medical and prescription benefits. With that, you are guaranteed coverage for yourself, your spouse, and unmarried children under 25.
In order to process claims under this policy, you must provide to us an Explanation of Benefits (EOB) for each claim you submit from your primary health insurance plan. No reimbursement or payment of any claim for eligible medical expenses under this policy shall be made until the claim is submitted for adjudication under the primary health insurance plan and adjudication and/ or payment has been made under the primary health insurance plan.
Other dread diseases are also covered by this important plan
In addition to cancer, CMRP extends similar supplemental coverage for a variety of other dread diseases. Reimbursement is limited to a lifetime maximum of $25,000. The plan includes the following ailments diagnosed by a doctor of medicine.
- Brain Tumor
- Primary Encephalitis
- Typhoid Fever
- Rheumatic Fever
- Emphysema
- Rabies
- Diphtheria
- Primary Spinal Meningitis
- Multiple Sclerosis
- Scarlet Fever
- Poliomyelitis
- Tuberculosis
- Parkinson’s Disease
- Tetanus
- Muscular Dystrophy
- Small Pox
Pre-Existing Conditions
A pre-existing condition is any cancer or covered disease, first diagnosed prior to the effective date of the participant’s coverage or within 30 days following the effective date of the participant’s coverage. Coverage will be available for the pre-existing condition on the date that a participant completes twelve (12) consecutive months of coverage under this plan.
Requirements
A primary health insurance plan is required for CMRP eligibility. CMRP is never a primary health insurance plan. The effect of termination or change in the primary health insurance plan or failure of the primary health insurance plan to pay may affect CMRP eligibility.
CMRP coverage is offered only to persons already covered by a primary health insurance plan that offers comprehensive medical care and expense benefits. In order to be eligible to enroll in the CMRP plan, you must belong to a participating group.
Exclusions & Limitations (Benefits will not be paid for)
- Any loss due to injury, disease, sickness or incapacity, unless such treatment is directly related to or attributable to cancer or specified dread diseases.
- Care received outside the United States
- Experimental drugs or substances not approved by the U.S. Food and Drug Administration (FDA) for the treatment of cancer.
- Experimental procedures or treatment methods not endorsed by the American Medical Association or any other appropriate medical society.
- Courses of treatment available without a doctor’s prescription.
- Treatment, services, or supplies received form a covered person’s family member.
- Any loss not covered by a covered person’s health insurance plan
Cancer means Leukemia, Hodgkin’s disease, or any malignant growth, which is positively identified as cancer (malignant neoplasm) by a licensed doctor of medicine or osteopathy, other than participant, and based on bioptic examination performed by a recognized pathologist.
This brochure is a summary of the benefits, limitations, and conditions as contained in the CMRP policy and does not include all benefit limitations and conditions to coverage. You should consult the policy and certificate to view all benefit conditions and limitations. Eligibility is also subject to completion of a signed application.
Cancer Medical Reimbursement plans powered by AmFirst exclusively for HGEA Members
When will my AmFirst coverage begin?
Your coverage effective date is based on the payment method elected (ACH or Payroll Deduction).
ACH: Coverage effective date is the 1st of the month following date of enrollment.
Payroll Deduction: If the enrollment is received on or before the 23rd of the month, the effective date will be the first of the month following 60 days. IF after the 23rd of the month, the coverage will begin on the first of the month following 90 days.
Am I eligible to enroll if I am an Associate Member?
Yes. You must elect ACH payment. Payroll deduction will not be available.
Am I eligible to enroll if I am a Retired Member?
Yes. You must elect ACH payment.
When will my first payroll deduction begin?
On your next payroll deduction if the enrollment is received on or prior to the 23rd of the month.
When will my first ACH payment be taken?
Your initial payment will be taken within 3 business days of completing your enrollment. After initial payment, your scheduled draft date will be the 1st of each month.
What should I except to see on my Bank Statement for my premium payments?
“8888593795 Insurance” will appear on your statement as a description of the charge for your premiums.
I am a member of HGEA, and my spouse is also a member. Can we both elect coverage for each other under the new AmFirst Cancer Medical Reimbursement plan?
No. A person may be covered only once under the plan as an Employee, Spouse or Dependent Child.
If I do not elect coverage for myself, can I elect coverage for my spouse and/or dependent child(ren)?
No. A member must elect coverage for him/herself in order to be eligible to elect family coverage.
Do I need to have major medical coverage for this plan to pay?
Yes. This plan operates as a supplement to a qualifying Primary Health Insurance Plan. If the Primary Health Insurance Plan is Medicare, it must include Parts A & B and a paid supplemental plan that, when combined with Medicare, pays at least 70% of eligible medical benefits.
Does this plan cover other Dread Diseases?
This plan covers Specified Dread Diseases that are positively identified by a licensed Doctor of Medicine or Osteopathy based, as necessary, on results of tissue examination by a recognized Pathologist. A listing of the covered Specified Dread Diseases is contained in the certificate of coverage.
Available in: AL, AZ, AR, FL, HI, LA, MD, MI, MS, NC, OH, OK, PA, SC, TN, TX, VA, WV
